Pilot study to identify risk factors for susceptibility to anthrax and evaluate antitoxin effectiveness for systemic anthrax

The purpose of this requirement is to work in an anthrax endemic area with high standards of in-hospital medical care to 1) collect data on clinical outcomes of an antitoxin in the group for whom it would be indicated in the US, i.e., patients with systemic anthrax; 2) assess the prevalence of oxidatively stressing common chronic diseases and exposures so that the Government can later design a case-control study to identify demographic, dietary, or social (e.g., smoking, drinking) variables or comorbidities that might serve as risk factors for anthrax morbidity and mortality; and 3) collect, store, and characterize isolates determined to exhibit antimicrobial resistance by correlating whole genome sequence changes to resistance levels (Broth Microdilution). Understanding 1) how well antitoxins work in a hospital setting, 2) whether any conditions or habits increase risk for B. anthracis infection, and 3) whether there are natural factors that contribute to the development of resistance will enhance USG biopreparedness for a wide-area release of B. anthracis.

The Kyrgyz Republic, which is endemic for anthrax, regularly identifies human anthrax cases.  Treatment protocols are standardized and a consistent level of care is provided to patients with anthrax diagnoses. Moderate to severe cases are diagnosed annually, which is the target group for receiving antitoxin; because all anthrax cases are hospitalized, administration of antitoxin and collection of biomarker data is more possible than it would be in other anthrax-endemic countries with less developed healthcare infrastrucutre. Care is more consistent with US treatment protocols compared to treatment practices in many other anthrax-endemic countries.